Maiuri F, Gambardella A, Trinchillo G
Department of Neurosurgery, 2nd School of Medicine, University of Naples, Italy.
Neurol Res. 1989 Dec;11(4):238-44. doi: 10.1080/01616412.1989.11739899.
Seven adult patients with congenital lumbosacral lesions and clinical onset in adult life are reported. All also had an abnormally low and tethered spinal cord. A thickened filum terminale and a spinal lipoma are the most common lesions in adults, whereas others, including diastematomyelia, fibrous adhesions, previous meningocele repair and dermal sinus are more rare. Although water-soluble myelography visualizes the abnormally low conus well and may diagnose a diastematomyelia and a thickened filum, computerized tomography, CT myelography and magnetic resonance may provide a better diagnostic definition of the other abnormalities. Surgical treatment should be performed in all adult patients with progressive symptoms. Transection of the thickened filum or of fibrous adhesions and the removal of a spinal lipoma, diastematomyelia septum or dermal sinus tract, result in remission of the pain and improvement of the sensorimotor deficits, or at least prevent the progression of the neurological troubles.
本文报告了7例成年患者，他们患有先天性腰骶部病变且在成年期发病。所有患者还伴有脊髓位置异常偏低且受牵拉。终丝增厚和脊髓脂肪瘤是成年人中最常见的病变，而其他病变，包括脊髓纵裂、纤维粘连、既往脑脊膜膨出修补术和皮样窦则较为罕见。尽管水溶性脊髓造影能很好地显示低位圆锥异常，可能诊断出脊髓纵裂和终丝增厚，但计算机断层扫描、CT脊髓造影和磁共振成像可能能更好地明确其他异常的诊断。所有出现进行性症状的成年患者均应接受手术治疗。切断增厚的终丝或纤维粘连，切除脊髓脂肪瘤、脊髓纵裂间隔或皮样窦道，可使疼痛缓解，感觉运动功能障碍改善，或至少防止神经功能障碍进展。
